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Observational Study
. 2024 Jan 23;28(1):32.
doi: 10.1186/s13054-024-04807-4.

Incidence, diagnosis, management and outcome of acute mesenteric ischaemia: a prospective, multicentre observational study (AMESI Study)

Annika Reintam Blaser  1   2 , Merli Mändul  3   4 , Martin Björck  5   6 , Stefan Acosta  7 , Miklosh Bala  8 , Zsolt Bodnar  9 , Dumitru Casian  10 , Zaza Demetrashvili  11 , Mario D'Oria  12 , Virginia Durán Muñoz-Cruzado  13 , Alastair Forbes  5 , Hanne Fuglseth  14 , Moran Hellerman Itzhaki  15 , Benjamin Hess  16 , Karri Kase  5   17 , Mikhail Kirov  18 , Kristoffer Lein  19 , Matthias Lindner  20 , Cecilia Inés Loudet  21 , Damian J Mole  22 , Marko Murruste  5   17 , Alexandre Nuzzo  23 , Sten Saar  24 , Maximilian Scheiterle  25 , Joel Starkopf  5   17 , Peep Talving  5   24 , Anna-Liisa Voomets  17 , Kenneth K T Voon  26 , Mohammad Alif Yunus  27 , Kadri Tamme  5   17 ; AMESI Investigators (Collaborators)
Collaborators, Affiliations
Observational Study

Incidence, diagnosis, management and outcome of acute mesenteric ischaemia: a prospective, multicentre observational study (AMESI Study)

Annika Reintam Blaser et al. Crit Care. .

Abstract

Background: The aim of this multicentre prospective observational study was to identify the incidence, patient characteristics, diagnostic pathway, management and outcome of acute mesenteric ischaemia (AMI).

Methods: All adult patients with clinical suspicion of AMI admitted or transferred to 32 participating hospitals from 06.06.2022 to 05.04.2023 were included. Participants who were subsequently shown not to have AMI or had localized intestinal gangrene due to strangulating bowel obstruction had only baseline and outcome data collected.

Results: AMI occurred in 0.038% of adult admissions in participating acute care hospitals worldwide. From a total of 705 included patients, 418 patients had confirmed AMI. In 69% AMI was the primary reason for admission, while in 31% AMI occurred after having been admitted with another diagnosis. Median time from onset of symptoms to hospital admission in patients admitted due to AMI was 24 h (interquartile range 9-48h) and time from admission to diagnosis was 6h (1-12 h). Occlusive arterial AMI was diagnosed in 231 (55.3%), venous in 73 (17.5%), non-occlusive (NOMI) in 55 (13.2%), other type in 11 (2.6%) and the subtype could not be classified in 48 (11.5%) patients. Surgery was the initial management in 242 (58%) patients, of which 59 (24.4%) underwent revascularization. Endovascular revascularization alone was carried out in 54 (13%), conservative treatment in 76 (18%) and palliative care in 46 (11%) patients. From patients with occlusive arterial AMI, revascularization was undertaken in 104 (45%), with 40 (38%) of them in one site admitting selected patients. Overall in-hospital and 90-day mortality of AMI was 49% and 53.3%, respectively, and among subtypes was lowest for venous AMI (13.7% and 16.4%) and highest for NOMI (72.7% and 74.5%). There was a high variability between participating sites for most variables studied.

Conclusions: The overall incidence of AMI and AMI subtypes varies worldwide, and case ascertainment is challenging. Pre-hospital delay in presentation was greater than delays after arriving at hospital. Surgery without revascularization was the most common management approach. Nearly half of the patients with AMI died during their index hospitalization. Together, these findings suggest a need for greater awareness of AMI, and better guidance in diagnosis and management.

Trial registration: NCT05218863 (registered 19.01.2022).

Keywords: Diagnosis; Epidemiology; Management; Mesenteric ischaemia; Outcome.

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Conflict of interest statement

ARB has received speaker or consultancy fees from Nestlé, VIPUN Medical, Nutricia and Fresenius Kabi, and is holding a grant from Estonian Research Council (PRG1255). AF has received speaker fees from B Braun and Fresenius Kabi. AN has received speaker or consultancy fees from Abbvie and Janssen, research funding from MSD-Avenir, and PhD grants from Fondation de l’Avenir and SNFGE. SA, MBa, MBj, ZB, DC, MD, ZD, VDMC, HF, MH, BH, KK, MK, KL, ML, CIL, DJM, MMu, MMä, SS, MS, JS, PT, ALV, KV, MAY and KT declare no conflicts of interest. All authors completed the ICMJE uniform conflict of interest disclosure form.

Figures

Fig. 1
Fig. 1
Flow chart. Legend: AMI—acute mesenteric ischaemia
Fig. 2
Fig. 2
Incidence of AMI (% of admissions) in different sites and in total
Fig. 3
Fig. 3
Locations and timing of diagnosis. Legend: AMI—acute mesenteric ischaemia; ED—emergency department; ICU—intensive care unit
See this image and copyright information in PMC

Comment in

References

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